Dissertations / Theses on the topic 'Medical training system'

Ultrasound is an effective imaging modality because it is safe, unobtrusive and portable. However, it is also very operator-dependent and significant skill is required to capture quality images and properly detect abnormalities. Training is an important part of ultrasound, but the limited availability of training courses presents a significant hindrance to the use of ultrasound being used in additional settings. The goal of this work was to design and implement an interactive training system to help train and evaluate sonographers. The Interactive Training System for Medical Ultrasound is an inexpensive, software-based training system in which the trainee scans a lifelike manikin with a sham transducer containing a 6 degree of freedom tracking sensor. The observed ultrasound image is generated from a pre-stored 3D image volume and is controlled interactively by the sham transducer's position and orientation. Based on the selected 3D volume, the manikin may represent normal anatomy, exhibit a specific trauma or present a given physical condition. The training system provides a realistic scanning experience by providing an interactive real-time display with adjustable image parameters such as scan depth, gain, and time gain compensation. A representative hardware interface has been developed including a lifelike manikin and convincing sham transducers, along with a touch screen user interface. Methods of capturing 3D ultrasound image volumes and stitching together multiple volumes have been evaluated. System performance was analyzed and an initial clinical evaluation was performed. This thesis presents a complete prototype training system with advanced simulation and learning assessment features. The ultrasound training system can provide cost-effective and convenient training of physicians and sonographers. This system is an innovative approach to training and is a powerful tool for training sonographers in recognizing a wide variety of medical conditions.

"Ultrasound has become a widely used form of medical imaging because it is low-cost, safe, and portable. However, it is heavily dependent on the skill of the operator to capture quality images and properly detect abnormalities. Training is a key component of ultrasound, but the limited availability of training courses and programs presents a significant obstacle to the wider use of ultrasound systems. The goal of this work was to design and implement an interactive training system to help train and evaluate sonographers. This Virtual Training System for Diagnostic Ultrasound is an inexpensive, software-based training system in which the trainee scans a generic scan surface with a sham transducer containing position and orientation sensors. The observed ultrasound image is generated from a pre-stored 3D image volume and is controlled interactively by the user€™s movements of the sham transducer. The patient in the virtual environment represented by the 3D image data may depict normal anatomy, exhibit a specific trauma, or present a given physical condition. The training system provides a realistic scanning experience by providing an interactive real-time display with adjustable image parameters similar to those of an actual diagnostic ultrasound system. This system has been designed to limit the amount of hardware needed to allow for low-cost and portability for the user. The system is able to utilize a PC to run the software. To represent the patient to be scanned, a specific scan surface has been produced that allows for an optical sensor to track the position of the sham transducer. The orientation of the sham transducer is tracked by using an inexpensive inertial measurement unit that relies on the use of quaternions to be integrated into the system. The lack of a physical manikin is overcome by using a visual implementation of a virtual patient in the software along with a virtual transducer that reflects the movements of the user on the scan surface. Pre-processing is performed on the selected 3D image volume to provide coordinate transformation parameters that yield a least-mean square fit from the scan surface to the scanning region of the virtual patient. This thesis presents a prototype training system accomplishing the main goals of being low-cost, portable, and accurate. The ultrasound training system can provide cost-effective and convenient training of physicians and sonographers. This system has the potential to become a powerful tool for training sonographers in recognizing a wide variety of medical conditions."

The field of medical education is an ever evolving area constantly enriched by newly discovered information and changing facts provided by active research in all areas of medicine. The recent years have witnessed the introduction of a number of promising technologies and applications to medical education to meet this demand. Virtual Reality (VR) applications are considered one of the evolving methods that have contributed to enhancing medical education. This Thesis utilises Virtual Reality to provide a solution to improve the delivery of the subject of anatomy to medical students, and facilitate the teaching process by providing a useful aid to lecturers, whilst proving the effectiveness of this new technology in this particular area. An intensive investigation into the current anatomy teaching system in the Faculty of Medicine in the University of Jordan was carried out and the challenges this system faces were characterised. The lecturers and students needs and requirements were identified, and measured against the perceived training system adapting the SERVQUAL instrument, and limitations associated with current teaching modalities were defined. In order to overcome these limitations and enhance the anatomy education process, a novel system was developed utilising VR technology. This system offers a real-time 3D representation of the heart in an interactive VR environment that provides self-directed learning and assessment tools through a variety of interfaces and functionalities. The effectiveness of VR technology and the usefulness of the developed system in improving the understanding of the anatomical structures were proven through a randomised controlled study. In order to assure future utilisation of the system by teaching staff and students in the Faculty of Medicine, further evaluation was conducted adapting the Technology Acceptance Model. This confirmed the end users' acceptance of the system as a teaching and learning aid, and their intention to incorporate it into the anatomy education process in the future.

Dans le secteur médical tout particulièrement, la qualité du geste est primordiale et les professionnels doivent être formés par la pratique pour acquérir un niveau de compétences compatible avec l'exercice de leur métier. Depuis une dizaine d'année, les simulateurs informatiques aident les apprenants dans de nombreux apprentissages mais ils doivent encore être associés à des travaux pratiques sur mannequins, animaux ou cadavres, qui pourtant n'offrent pas toujours suffisamment de réalisme par rapport aux vrais patients, et sont coûteux à l'usage. Aussi, leur formation s'achève généralement sur de vrais patients, ce qui présente des risques. Les simulateurs haptiques (fournissant une sensation d'effort) deviennent aujourd'hui une solution plus appropriée car ils peuvent reproduire des efforts résistant réalistes et proposer une infinité de cas d'étude pré-enregistrés. Cependant, apprendre seul sur un simulateur n'est pas toujours aussi efficace qu'un apprentissage "à quatre mains" (celles de l'instructeur et de l'apprenant manipulant les mêmes outils en coopération). Cette étude propose donc un système haptique de formation pratique à deux utilisateurs : l'instructeur et l'apprenant, interagissant chacun à travers leur propre interface haptique. Ils collaborent ainsi, avec des outils et un environnement de travail soit réels (l'outil est manipulé par un robot) soit virtuels. Une approche énergétique, faisant appel notamment à la modélisation par port-Hamiltonien, a été utilisée pour garantir la stabilité et la robustesse du système. Une étude comparative (en simulation) avec deux autres systèmes haptiques multi utilisateurs a montré l'intérêt de ce nouveau système pour la formation pratique. Il a été développé et validé expérimentalement sur des interfaces à un seul degré de liberté. Son extension à six degrés de liberté est facilitée par les choix de modélisation. Afin de pouvoir utiliser le système quand les deux protagonistes sont éloignés, cette étude propose des pistes d'amélioration qui ne sont pas encore optimisées
More particularly in the medical field, gesture quality is primordial. Professionals have to follow hands-on trainings to acquire a sufficient level of skills in the call of duty. For a decade, computer based simulators have helped the learners in numerous learnings, but these simulations still have to be associated with hands-on trainings on manikins, animals or cadavers, even if they do not always provide a sufficient level of realism and they are costly in the long term. Therefore, their training period has to finish on real patients, which is risky. Haptic simulators (furnishing an effort feeling) are becoming a more appropriated solution as they can reproduce realist efforts applied by organs onto the tools and they can provide countless prerecorded use cases. However, learning alone on a simulator is not always efficient compared to a fellowship training (or supervised training) where the instructor and the trainee manipulate together the same tools. Thus, this study introduces an haptic system for supervised hands-on training: the instructor and the trainee interoperate through their own haptic interface. They collaborate either with a real tool dived into a real environment (the tool is handled by a robotic arm), or with a virtual tool/environment. An energetic approach, using in particular the port-Hamiltonian modeling, has been used to ensure the stability and the robustness of the system. This system has been designed and validated experimentally on a one degree of freedom haptic interface. A comparative study with two other dual-user haptic systems (in simulation) showed the interest of this new architecture for hands-on training. In order to use this system when both users are away from each other, this study proposes some enhancements to cope with constant communication time delays, but they are not optimized yet

Aims The purpose of this study is to explore the possibilities for video-based learning of computer systems in the field of medical education in rural sub-Saharan Africa. Background Low-income countries are forced to perform healthcare services with resources already spread too thin. The use of electronic medical records can increase the cost-effectiveness of delivering healthcare services, but the low computer literacy in sub-Saharan Africa is an obstacle necessary to overcome. E-learning and video-based learning has the potential to partially solve this problem. Methods User observations were conducted on five healthcare workers in rural Uganda. The users watched an instruction video, after which they performed an assessment test of an electronic medical record system. Results Some effectiveness was perceived – but it was slight, and varied greatly between the test subjects. Computer experience is an important prerequisite for the success of e-learning initiatives. Effectiveness was higher for more simple tasks. Conclusion This paper does not propose video-based learning as the only source of training for the target group. However, there is a possibility to envision video-based learning as a building block in a blended-learning strategy – utilising video-based learning for easier tasks and knowledge retention for users who are already familiar with the system.

Im Beruf, in der Freizeit und in der Rehabilitation werden immer öfter digitale Medien eingesetzt. Speziell in der motorischen Rehabilitation wird zunehmend eine Digitalisierung der Therapieprozesse festgestellt. Dieser Trend soll den Therapieprozess dokumentieren, die Patienten motivieren und auch eine Unterstützung für die Therapeuten sein. Gegenwärtig werden in der Praxis verschiedene „Feedback-Informationen“ verwendet, beispielsweise Informationen zum Bewegungsweg und zur Bewegungsgeschwindigkeit. In der Regel kommen diese Informationen primär vom Trainingsgerät, da dort die entsprechenden Sensoren angebracht sind. Die Information zur Bewegungsqualität des Patienten selbst, wird von den Sensoren nicht erfasst. Im Rahmen des Projektes „AssiSt“ (Assistierte Bewegungskontrolle in der Rehabilitation durch intelligente Sensortechnologie) wurde ein anderer Ansatz verfolgt. Hier war es das Ziel, ein Assistenzsystem zu entwickeln, welches einem Patienten während seiner Übungsausführung Feedback geben kann. Es galt dabei zu prüfen, inwiefern mit einem optischen Sensor die Bewegung des Übenden direkt erfasst und in Echtzeit auf fehlerhafte Bewegungsausführungen/oder die/eine fehlerhafte Bewegungsausführung analysiert werden kann. Eine falsche Bewegungsausführung kann dazu führen, dass die Zielmuskulatur nicht richtig angesteuert wird. Darüber hinaus können aktive und passive Strukturen in der frühen postoperativen Phase überlastet werden. Hierfür wurde mithilfe von Methoden des maschinellen Lernens die Bewegung des Übenden auf Fehlerbilder hin analysiert. Bei fehlerhafter Ausführung werden dabei über eine Feedbackeinheit sofort Korrekturhinweise übermittelt, sodass auftretende Fehler zeitnah korrigiert werden können. Im Verlauf klinischer Tests wurde das Feedback des Assistenzsystems mit der Analyse eines Therapeuten verglichen, wobei eine gute Übereinstimmung erzielt wurde. Neben der Bewegungsanalyse wird durch das System zusätzlich eine Verlaufsdokumentation erstellt, sodass Patienten und Therapeuten nachträglich den Therapieverlauf auswerten können. Darüber hinaus wurde untersucht, ob Biosignale, wie bspw. die Erwärmung der Hautoberfläche infolge der Muskelarbeit während des Trainings, als Feedback geeignet sind. Dies könnte das Effektwissen des Patienten durch ein besseres Verständnis zwischen der Therapieübung und der Muskelansteuerung verbessern.

Doutoramento em Ciências e Tecnologias da Saúde
Nervous system disorders are associated with cognitive and motor deficits, and are responsible for the highest disability rates and global burden of disease. Their recovery paths are vulnerable and dependent on the effective combination of plastic brain tissue properties, with complex, lengthy and expensive neurorehabilitation programs. This work explores two lines of research, envisioning sustainable solutions to improve treatment of cognitive and motor deficits. Both projects were developed in parallel and shared a new sensible approach, where low-cost technologies were integrated with common clinical operative procedures. The aim was to achieve more intensive treatments under specialized monitoring, improve clinical decision-making and increase access to healthcare. The first project (articles I – III) concerned the development and evaluation of a web-based cognitive training platform (COGWEB), suitable for intensive use, either at home or at institutions, and across a wide spectrum of ages and diseases that impair cognitive functioning. It was tested for usability in a memory clinic setting and implemented in a collaborative network, comprising 41 centers and 60 professionals. An adherence and intensity study revealed a compliance of 82.8% at six months and an average of six hours/week of continued online cognitive training activities. The second project (articles IV – VI) was designed to create and validate an intelligent rehabilitation device to administer proprioceptive stimuli on the hemiparetic side of stroke patients while performing ambulatory movement characterization (SWORD). Targeted vibratory stimulation was found to be well tolerated and an automatic motor characterization system retrieved results comparable to the first items of the Wolf Motor Function Test. The global system was tested in a randomized placebo controlled trial to assess its impact on a common motor rehabilitation task in a relevant clinical environment (early post-stroke). The number of correct movements on a hand-to-mouth task was increased by an average of 7.2/minute while the probability to perform an error decreased from 1:3 to 1:9. Neurorehabilitation and neuroplasticity are shifting to more neuroscience driven approaches. Simultaneously, their final utility for patients and society is largely dependent on the development of more effective technologies that facilitate the dissemination of knowledge produced during the process. The results attained through this work represent a step forward in that direction. Their impact on the quality of rehabilitation services and public health is discussed according to clinical, technological and organizational perspectives. Such a process of thinking and oriented speculation has led to the debate of subsequent hypotheses, already being explored in novel research paths.
As doenças do sistema nervoso estão associadas a défices cognitivos e motores, sendo responsáveis pelas maiores taxas de incapacidade e impacto global. A sua recuperação é difícil e depende em simultâneo da plasticidade cerebral e de programas de neurorreabilitação complexos, longos e dispendiosos. Este trabalho explora duas linhas de investigação, que visam soluções sustentáveis para melhoria do tratamento de défices cognitivos e motores. Ambos os projetos foram desenvolvidos em paralelo, partilhando uma abordagem assisada onde se combinam tecnologias de baixo custo com processos clínicos comuns. O objetivo era obter tratamentos mais intensivos e supervisionados, melhorar o processo de decisão clínica e eliminar barreiras no acesso aos cuidados de saúde. O primeiro projeto (artigos I – III) permitiu o desenvolvimento e avaliação de uma plataforma online para treino cognitivo (COGWEB), adequada para uso intensivo, em casa ou instituições, e num largo espectro de idades e doenças com envolvimento das funções cognitivas. A sua usabilidade foi testada numa consulta de memória, sendo de seguida implementada numa rede colaborativa que envolveu 41 centros e 60 profissionais. A taxa de adesão aos planos de treino cognitivo online foi 82,8% aos 6 meses, verificando-se uma intensidade média de 6 horas/semana. O segundo projeto (artigos IV – VI) originou a construção e validação de um dispositivo de reabilitação inteligente para doentes com acidente vascular cerebral (AVC). Permite estímulos proprioceptivos no lado hemiparético, enquanto caracteriza o movimento tridimensional em ambulatório (SWORD). A estimulação vibratória foi bem tolerada pelos doentes e um sistema automático de caracterização motora revelou resultados comparáveis aos de uma escala utilizada frequentemente na prática clínica. O sistema integrado foi testado num ensaio clínico randomizado e controlado com placebo para avaliação do impacto numa tarefa de reabilitação motora na fase subaguda após AVC. O número de movimentos correctos numa tarefa mão-boca aumentou em média 7,2/minuto, enquanto a probabilidade de ocorrência de erro se reduziu de 1:3 para 1:9. A neurorreabilitação e a neuroplasticidade têm incorporado abordagens de múltiplos domínios das neurociências. Em simultâneo, a sua utilidade para os doentes e sociedade está dependente do desenvolvimento de tecnologias mais eficazes que facilitem também a disseminação do conhecimento entretanto produzido. Os resultados obtidos através do presente trabalho representam um passo adicional nessa direcção. O seu impacto na qualidade dos serviços de reabilitação e saúde pública são discutidos segundo perspectivas clínica, tecnológica e organizacional. Este processo de reflexão foi gerador de novas hipóteses, algumas já em exploração através de linhas de investigação específicas.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Virtual Reality (VR) and systems that use its techniques have a recent story from the point of view of their social and practical application. The main idea related to VR refers to the use of three-dimensional environments in which users can explore and interact in virtual worlds and feel immersed and involved. Currently, works that use VR to teaching or conduct trainings are commonly found in literature. In medicine, VR have been used for realistic applications for training of critical procedures. Collaborative VR environments for medical training can allow students to share knowledge or to be assisted by a tutor during a simulation. The objective of this work is to present the process of developing a module for interactive collaboration for the CyberMed, a framework developed since 2004 to help building medical simulations with VR technologies. This module enables collaboration in medical applications with interaction among multiple users. The development of the module consisted on analyzing and defining a protocol for exchanging messages over network, and implementation of some forms of cooperation relevant to medical simulations. The results were a set of classes to support different devices provided by the framework, allowing collaboration by mouse, haptic and tracking devices. Applications were built to validate the module implemented and its integration with CyberMed. In particular, a simulation of the bone marrow harvest procedure was adapted to provide collaboration with touch and force feedback (haptic) among remote users. The integration of this new module enables the creation of collaborative medical simulations with CyberMed that can be used by professionals and students in the training of medical procedures.
A Realidade Virtual (RV) e sistemas que utilizam suas técnicas possuem uma história bastante recente sob o ponto de vista prático e social da sua aplicação. A RV é utilizada principalmente para a construção de ambientes tridimensionais nos quais usuários podem explorar e interagir em mundos virtuais e se sentirem imersos e/ou envolvidos durante este processo. Atualmente, trabalhos que utilizam a RV com o objetivo de ensinar ou realizar treinamentos são facilmente encontrados na literatura. Na Medicina, a RV destaca-se em aplicações realistas para treinamento de procedimentos críticos. A colaboração em ambientes de RV para treinamento médico permite que estudantes compartilhem seus conhecimentos ou que sejam auxiliados por um tutor durante uma simulação. O objetivo principal deste trabalho é o desenvolvimento de um módulo de colaboração interativa para o CyberMed, framework desenvolvido desde 2004 voltado para a construção de simulações médicas com RV. O desenvolvimento do módulo de colaboração consistiu inicialmente na análise e definição de um protocolo de troca de mensagens pela rede e das formas de colaboração relevantes para simulações médicas. A partir dos resultados foi realizada a implementação de classes para suportar os diferentes dispositivos de interação disponibilizados pelo framework, permitindo a colaboração através de mouse, dispositivos hápticos e dispositivos de rastreamento. Após o desenvolvimento do módulo e sua integração ao CyberMed foram construídas aplicações para validar as novas funcionalidades. Em particular, uma simulação de procedimento de coleta de medula óssea foi adaptada para prover colaboração com sensação de toque e força (háptica) entre usuários dispostos remotamente. O novo módulo juntamente com o restante do framework possibilita a criação de simulações médicas colaborativas que podem ser utilizadas por profissionais e estudantes no treinamento de procedimentos médicos.

The Protein Data Bank (PDB) is the definitive electronic repository for experimentally-derived protein structures, composed mainly of those determined by X-ray crystallography. Approximately 200 new structures are added weekly to the PDB, and at the time of writing, it contains approximately 97,000 structures. This represents an expanding wealth of high-quality information but there seem to be few bioinformatics tools that consider and analyse these data as an ensemble. This thesis explores the development of three efficient, fast algorithms and software implementations to study protein structure using the entire PDB. The first project is a crystal-form matching tool that takes a unit cell and quickly (< 1 second) retrieves the most related matches from the PDB. The unit cell matches are combined with sequence alignments using a novel Family Clustering Algorithm to display the results in a user-friendly way. The software tool, Nearest-cell, has been incorporated into the X-ray data collection pipeline at the Diamond Light Source, and is also available as a public web service. The bulk of the thesis is devoted to the study and prediction of protein disorder. Initially, trying to update and extend an existing predictor, RONN, the limitations of the method were exposed and a novel predictor (called MoreRONN) was developed that incorporates a novel sequence-based clustering approach to disorder data inferred from the PDB and DisProt. MoreRONN is now clearly the best-in-class disorder predictor and will soon be offered as a public web service. The third project explores the development of a clustering algorithm for protein structural fragments that can work on the scale of the whole PDB. While protein structures have long been clustered into loose families, there has to date been no comprehensive analytical clustering of short (~6 residue) fragments. A novel fragment clustering tool was built that is now leading to a public database of fragment families and representative structural fragments that should prove extremely helpful for both basic understanding and experimentation. Together, these three projects exemplify how cutting-edge computational approaches applied to extensive protein structure libraries can provide user-friendly tools that address critical everyday issues for structural biologists.

La problématique des ressources humaines est complexe. Elle a donc besoin de cadres conceptuels pour décoder la réalité et cerner les limites de ses actions. La présentation d'un cadre théorique qui questionne les niveaux d'adéquation entre formation et compétences attendues des professionnels de la santé (à la fois dans le champ de la santé et dans celui de l'éducation) est l’aboutissement d'une réflexion sur la formation appréhendée comme voie d’accès à l’innovation, elle-même levier de changement dans la gestion des ressources humaines en santé. La démarche systémique appliquée à cette problématique et dans plusieurs contextes permet une action cohérente aux niveaux national, régional et local, tout en respectant la complexité de l’ensemble ainsi que les contraintes relatives aux mécanismes des marchés internationaux. L'importance du processus et de l'ensemble des acteurs concernés par le changement est analysée, mettant en évidence plus particulièrement la nécessité d’une appropriation, dès le départ, d’un cadre de référence et de sa mise en œuvre par les enseignants et les équipes de directions aux différents niveaux institutionnels.

L’adéquation des programmes à leurs contextes d’application et le renforcement des compétences des professionnels sont les questions centrales posées par cette recherche à travers la mise en œuvre de l’approche par compétences et des pédagogies actives. Les finalités sont celles de la mise en évidence des mécanismes, facteurs et visions nécessaires à l'amélioration de la formation des professionnels de santé et la promotion d’un « enseignement – apprentissage » favorable à l'intégration des principes d’actions de promotion et d'éducation à la santé. Ces finalités sont au centre des résultats recherchés dans ces vastes chantiers. Elles réclament un travail de fond sur la question du sens des apprentissages, dont la mise en réseau avec des centres de formation et d'expertise, ainsi que le développement de l'autonomie d'une masse critique de professionnels de santé. Parmi ces derniers, les infirmier(ère)s de première ligne sont responsables dans de nombreux contextes de plus de 80 % de l'offre de services. L'application de cette approche sur plusieurs terrains d'actions viendra renforcer les cadres théoriques et la méthodologie proposés.

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Cette thèse est articulée de manière à présenter des articles sur la formation et la gestion des ressources humaines en santé dans un ensemble cohérent. Certaines redondances dans la présentation des contextes et des méthodes sont de ce fait inévitables. Chacune des parties commence par une introduction et un cadrage qui devraient permettre de se situer quant aux objectifs et aux contenus spécifiques de la partie concernée. Un débat peut ouvrir une partie tout comme une discussion peut la clore. Dans un souci de lisibilité, un lexique propre à cette thèse est donné en annexe, plus particulièrement aux champs de la pédagogie (annexe 1) et de la santé publique (annexe 2). Les mots et concepts qui se trouvent dans ce lexique sont soulignés la première fois qu’ils sont rencontrés dans le texte (à l’exception des articles).

Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished

La present tesi doctoral s’ha centrat en el repte d’aconseguir, mitjançant Fabricació Additiva (FA), models per a assaig quirúrgic, sota la premissa que els equips per fer-los haurien de ser accessibles a l’àmbit hospitalari. L’objectiu és facilitar l’extensió de l’ús dels prototips com a eina de preparació d’operacions quirúrgiques, transformant la pràctica mèdica actual de la mateixa manera que en el seu moment ho van fer tecnologies com les que van facilitar l’ús de radiografies. El motiu d’utilitzar FA, en lloc de tecnologies més tradicionals, és la seva capacitat de materialitzar de forma directa les dades digitals obtingudes de l’anatomia del pacient mitjançant sistemes d’escanejat tridimensional, fent possible l’obtenció de models personalitzats. Els resultats es centren en la generació de nou coneixement sobre com aconseguir equipaments d’impressió 3D multimaterials accessibles que permetin l’obtenció de models mimètics respecte als teixits vius. Per facilitar aquesta buscada extensió de la tecnologia, s’ha focalitzat en les tecnologies de codi obert com la Fabricació per Filament Fos (FFF) i similars basades en líquids catalitzables. La recerca s’alinea dins l’activitat de desenvolupament de la FA al CIM UPC, i en aquest àmbit concret amb la col·laboració amb l’Hospital Sant Joan de Déu de Barcelona (HSJD). El primer bloc de la tesi inclou la descripció de l’estat de l’art, detallant les tecnologies existents i la seva aplicació a l’entorn mèdic. S’han establert per primer cop unes bases de caracterització dels teixits vius -sobretot tous- per donar suport a la selecció de materials que els puguin mimetitzar en un procés de FA, a efectes de millorar l’experiència d’assaig dels cirurgians. El caràcter rígid dels materials majoritàriament usats en impressió 3D els fa poc útils per simular tumors i altres referències anatòmiques. De forma successiva, es tracten paràmetres com la densitat, la viscoelasticitat, la caracterització dels materials tous a la indústria, l’estudi del mòdul elàstic de teixits tous i vasos, la duresa d’aquests, i requeriments com l’esterilització dels models. El segon bloc comença explorant la impressió 3D mitjançant FFF. Es classifiquen les variants del procés des del punt de vista de la multimaterialitat, essencial per fer models d’assaig quirúrgic, diferenciant entre solucions multibroquet i de barreja al capçal. S’ha inclòs l’estudi de materials (filaments i líquids) que serien més útils per mimetitzar teixits tous. Es constata com en els líquids, en comparació amb els filaments, la complexitat del treball en processos de FA és més elevada, i es determinen formes d’imprimir materials molt tous. Per acabar, s’exposen sis casos reals de col·laboració amb l’HJSD, una selecció d’aquells en els que el doctorand ha intervingut en els darrers anys. L’origen es troba en la dificultat de l’abordatge d’operacions de resecció de tumors infantils com el neuroblastoma, i a la iniciativa del Dr. Lucas Krauel. Finalment, el Bloc 3 té per objecte explorar nombrosos conceptes (fins a 8), activitat completada al llarg dels darrers cinc anys amb el suport dels mitjans del CIM UPC i de l’activitat associada a treballs finals d’estudis d’estudiants de la UPC, arribant-se a materialitzar equipaments experimentals per validar-los. La recerca ampla i sistemàtica al respecte fa que s’estigui més a prop de disposar d’una solució d’impressió 3D multimaterial de sobretaula. Es determina que la millor via de progrés és la de disposar d’una pluralitat de capçals independents a fi de capacitar la impressora 3D per integrar diversos conceptes estudiats, materialitzant-se una possible solució. Cloent la tesi, es planteja com seria un equipament d’impressió 3D per a models d’assaig quirúrgic, a fi de servir de base per a futurs desenvolupaments.
La presente tesis doctoral se ha centrado en el reto de conseguir, mediante Fabricación Aditiva (FA), modelos para ensayo quirúrgico, bajo la premisa que los equipos para obtenerlos tendrían que ser accesibles al ámbito hospitalario. El objetivo es facilitar la extensión del uso de modelos como herramienta de preparación de operaciones quirúrgicas, transformando la práctica médica actual de la misma manera que, en su momento, lo hicieron tecnologías como las que facilitaron el uso de radiografías. El motivo de utilizar FA, en lugar de tecnologías más tradicionales, es su capacidad de materializar de forma directa los datos digitales obtenidos de la anatomía del paciente mediante sistemas de escaneado tridimensional, haciendo posible la obtención de modelos personalizados. Los resultados se centran en la generación de nuevo conocimiento para conseguir equipamientos de impresión 3D multimateriales accesibles que permitan la obtención de modelos miméticos respecto a los tejidos vivos. Para facilitar la buscada extensión de la tecnología, se ha focalizado en las tecnologías de código abierto como la Fabricación por Hilo Fundido (FFF) y similares basadas en líquidos catalizables. Esta investigación se alinea dentro de la actividad de desarrollo de la FA en el CIM UPC, y en este ámbito concreto con la colaboración con el Hospital Sant Joan de Déu de Barcelona (HSJD). El primer bloque de la tesis incluye la descripción del estado del arte, detallando las tecnologías existentes y su aplicación al entorno médico. Se han establecido por primera vez unas bases de caracterización de los tejidos vivos – principalmente blandos – para dar apoyo a la selección de materiales que los puedan mimetizar en un proceso de FA, a efectos de mejorar la experiencia de ensayo de los cirujanos. El carácter rígido de los materiales mayoritariamente usados en impresión 3D los hace poco útiles para simular tumores y otras referencias anatómicas. De forma sucesiva, se tratan parámetros como la densidad, la viscoelasticidad, la caracterización de materiales blandos en la industria, el estudio del módulo elástico de tejidos blandos y vasos, la dureza de los mismos, y requerimientos como la esterilización de los modelos. El segundo bloque empieza explorando la impresión 3D mediante FFF. Se clasifican las variantes del proceso desde el punto de vista de la multimaterialidad, esencial para hacer modelos de ensayo quirúrgico, diferenciando entre soluciones multiboquilla y de mezcla en el cabezal. Se ha incluido el estudio de materiales (filamentos y líquidos) que serían más útiles para mimetizar tejidos blandos. Se constata como en los líquidos, en comparación con los filamentos, la complejidad del trabajo en procesos de FA es más elevada, y se determinan formas de imprimir materiales muy blandos. Para acabar, se exponen seis casos reales de colaboración con el HJSD, una selección de aquellos en los que el doctorando ha intervenido en los últimos años. El origen se encuentra en la dificultad del abordaje de operaciones de resección de tumores infantiles como el neuroblastoma, y en la iniciativa del Dr. Lucas Krauel. Finalmente, el Bloque 3 desarrolla numerosos conceptos (hasta 8), actividad completada a lo largo de los últimos cinco años con el apoyo de los medios del CIM UPC y de la actividad asociada a trabajos finales de estudios de estudiantes de la UPC, llegándose a materializar equipamientos experimentales para validarlos. La investigación amplia y sistemática al respecto hace que se esté más cerca de disponer de una solución de impresión 3D multimaterial de sobremesa. Se determina que la mejor vía de progreso es la de disponer de una pluralidad de cabezales independientes, a fin de capacitar la impresora 3D para integrar diversos conceptos estudiados, materializándose una posible solución. Para cerrar la tesis, se plantea cómo sería un equipamiento de impresión 3D para modelos de ensayo quirúrgico, a fin de servir de base para futuros desarrollos.

碩士
國立成功大學
電腦與通信工程研究所
102
The purpose of this research is to design an innovative simulation scene training platform system with Asynchronous Transfer technology (AJAX) and Silverlight technology. This system allows instructors, through simple steps and materials, to build a simulation scene in which users can learn and be trained. After logging in the system through the browser, instructors are able to conduct and edit virtual scenes of using their own pictures with tools provided by the system such as annotation tools, action menu, customized properties and conditions with employment of scene settings and multimedia tools. The virtual scenes created by this system can furthermore be connected to external resources or imported other teaching materials to optimize their content. In the virtual scenes, instructors can even invent specific circumstance where users can proceed to their training repeatedly. When the training is completed, the system will review the users’ results and produce suggested correction, after which the test function can be put to use. The users are expected to increase their learning efficiency for receiving appropriate external stress from the test. In this way, it reflects the best description of the system as functions of both “teaching” and “learning”.

碩士
國立臺北科技大學
機電整合研究所
100
The Ultrasonic Image (Ultrasonography) Guided Medical Injection has been widely used as a medical treatment in Orthopedics and Neurology. However, the medical ultrasonography can only scan the sectional profile of patients’ infected area. Moreover, it usually requires the doctors’ experience to inject medicine accurately into the patients’ infected area during the image guided injection process. Therefore, the purpose of this research is to design and implement an ultrasonic image guided medical injection training system. This system can simulate the ultrasonic image guided medical injection process in virtual reality and provides an interactive training with the virtual images and equipment operation. With this virtual reality training simulation, doctors can thoroughly understands the spatial relationship between ultrasonic sectional image and needles of syringe. This research integrates the software of virtual reality and the spatial location of sensors. Two spatial location sensors are used separately in simulated mechanisms of ultrasonic probes and needles. On the other hand, the research develops the transformation of the fixed coordinates and the body coordinates of each sensor so that the training platform will not be restricted by the fixed coordinates. It also uses the 3D software to construct the ultrasonic image modules for training simulation. With these volume image files, this system can produce the sectional profiles to mimic the function of ultrasonic probes. With the Geometric Analysis algorithms developed in this research, the interaction of the ultrasonic sectional profile and the needles can be calculated and displayed on the image. A calculated needle-cross-section on the profile will be sized and oriented, which makes the simulating image resemble the real one vividly. The simulation training system developed in this research can make the ultrasonic image guided medical injection training easier and more efficient. It will help doctors to enhance their skills and reduce the malpractices of treatment in the real-world medical operations.

碩士
長庚大學
資訊管理學系
103
Nurses are the main human resources in clinical care. The purpose of the project, “post-graduate year training program”, to prepare graduated nurses for working in hospitals under the guidance of clinical teachers. In addition, nursing departments must develop learning portfolios for the various stages of such projects. However, most nursing departments use paper-based learning portfolios, many of which are inconvenient for managing nurse-training programs. Using a Web-based learning portfolio can solve the problems associated with paper-based learning portfolios. Therefore, this study transformed paper-based learning portfolios into Web-based learning portfolios to develop a nursing training support system that can be accessed by clinical teachers and graduated nurses. At the design stage, a questionnaire survey was administered to elucidate the needs of clinical teachers and graduated nurses regarding nursing training by conducting a requirements analysis. At the evaluation stage, the usability of the application was assessed through heuristic evaluation and focus groups. For the analysis, a requirements survey was administered to 40 graduated nurses and 42 clinical teachers. Their requirements were incorporated into the application functions. The developed application was evaluated by three experts through heuristic evaluation and usability testing and then modified according their suggestions. Finally, the nursing training support system was tested and improved by two groups of clinical teachers and graduated nurses according to a focus group method. Overall, graduated nurses and clinical teachers considered the proposed nursing training support system to be easy to use, and it assisted a nursing department in managing its learning portfolios and conducting data analyses.

碩士
國立臺灣科技大學
機械工程系
103
In this research we have designed a haptic surgical forceps system with two degree of freedom to reproduce the force felt by operator while gripping object using real minimally invasive surgery forceps. At first, we use load cell to measure the reaction force from surgical forceps when gripping objects. Second, kinematic analysis is performed to obtain the relationship between jaw and the grip end. The force equation with respect to the displacement is obtained for grasping different materials through curve fitting. Third, the curve fitted equation is applied to generate the required torque commands of the two axis motors so that the operator can feel its corresponding reaction force. Moreover, we can reproduce different types of reaction forces by changing parameters or adding the damping term to the force equation. Fourth, a virtual environment is constructed as a visual feedback interface in order to make operators feel more realistic in surgical operations. At last, we discuss our experiment data using Weber's law for psychophysical analysis. We can get just noticeable difference through some human factors experiments, and then discuss the influences of just-noticeable-difference in this study. In summary, the developed system which integrates force feedback and visual feedback can be applied as a good testing platform for surgical training simulation and further investigation for force rendering.

The thesis focuses on the profession of librarian and information professional in health care in the context of lifelong learning. The target group are professionals of information institutions in the network of public health information services in the Czech Republic. Content analysis of Czech and foreign materials and sociological quantitative research carried out by questionnaires in the Czech Republic's health information institutions are methods for analysing the needs of the librarian and information specialist in the health care sector in the Czech Republic. The output is a proposal of the concept of a lifelong professional education program called Competencies of the medical librarian for the performance of library and information activities. The lifelong education of medical librarians in connection with the concept of lifelong education of librarians in the Czech Republic is a process that will enable to gain necessary qualifications (professional knowledge and skills, general skills and soft skills) to perform this responsible and demanding profession.

This dissertation examined the application of a monitoring system in football(soccer). An observational design was adopted to analyse training load (TL) andphysical fitness measurements of two professional male football teams duringtheir regular training and match routines. During the competitive period, a highertraining volume was observed before and after playing against top-levelopponents (1st to 5th in the league rank), and after losing a match. Additionally, theamount of high-intensity activity performed during training was higher whenpreparing a game against a top-level opponent. Regarding TL-induced effects onphysical fitness, training volume was associated to a reduction of heart rateresponse during the submaximal Yo-Yo Intermittent Recovery Test - level 1,indicating improved cardiorespiratory fitness. Regarding the proper choice ofexternal TL quantification method, the use of arbitrary or individualised speedbasedintensity zones adjusted to player's physical fitness (maximal aerobicspeed and maximal sprinting speed) showed similar sensitivity in the estimationof external TL magnitude (based on correlation) but differed at their absolute level(based on measurement bias). Notwithstanding, when external TL was adjustedto individual physical fitness, it revealed slightly stronger associations withperceptual responses to training, rather than when calculated using arbitraryintensity zones. Additionally, reporting external TL values as percentage valuesof distance does not inform about player's perceptual responses to training. Thepresent findings can be considered by coaching and medical departments, andanyone involved with fitness testing and TL monitoring in football players.
Na presente dissertação foi examinada a aplicação de um sistema de avaliaçãoe controlo do treino em futebol. Os dados de carga de treino (CT) e a aptidãofísica foram recolhidos em duas equipas de futebol masculino profissional noâmbito das rotinas de treino e de jogo. Durante o período competitivo foiobservado um volume de treino mais elevado nas semanas antes e depois dacompetição contra adversários de topo (entre as primeiras 5 equipas daclassificação da liga) e depois dos jogos cujo resultado final foi a derrota.Adicionalmente, o volume de atividade intensa durante o treino foi mais elevadonas semanas antecedentes aos jogos contra adversários de topo. O volume detreino mostrou-se associado à redução na resposta da frequência cardíaca naversão submáxima do teste Yo-Yo Intermittent Recovery Test - level 1,sugerindo uma melhor aptidão cardiorrespiratória. Relativamente aos cuidadosa ter na escolha do método de quantificação da CT externa (CTE), a utilizaçãode zonas de intensidade baseadas em velocidades determinadas de formaarbitrária ou individualizada (ajustadas à aptidão física [velocidade aeróbiamáxima e velocidade máxima do jogador]) mostrou sensibilidade semelhantecom o cálculo da magnitude da CTE (estudo da correlação), mas diferiu emtermos de cálculo absoluto da CTE (estudo do viés de medição). A perceção daintensidade da sessão associou-se mais fortemente com a CTE ajustada áaptidão física individual do que quantificada com zonas de intensidade arbitrária.Além disto, a interpretação da CTE baseada em percentagens de distância nãoinformou acerca da perceção da carga em resposta ao treino. Estes resultadospodem ser considerados por profissionais envolvidos na área da avaliação físicae fisiológica do jogador de futebol.Palavras chave: Fisiologia, Desempenho, Aptidão física, Fadiga, Avaliação.

This dissertation examined the application of a monitoring system in football(soccer). An observational design was adopted to analyse training load (TL) andphysical fitness measurements of two professional male football teams duringtheir regular training and match routines. During the competitive period, a highertraining volume was observed before and after playing against top-levelopponents (1st to 5th in the league rank), and after losing a match. Additionally, theamount of high-intensity activity performed during training was higher whenpreparing a game against a top-level opponent. Regarding TL-induced effects onphysical fitness, training volume was associated to a reduction of heart rateresponse during the submaximal Yo-Yo Intermittent Recovery Test - level 1,indicating improved cardiorespiratory fitness. Regarding the proper choice ofexternal TL quantification method, the use of arbitrary or individualised speedbasedintensity zones adjusted to player's physical fitness (maximal aerobicspeed and maximal sprinting speed) showed similar sensitivity in the estimationof external TL magnitude (based on correlation) but differed at their absolute level(based on measurement bias). Notwithstanding, when external TL was adjustedto individual physical fitness, it revealed slightly stronger associations withperceptual responses to training, rather than when calculated using arbitraryintensity zones. Additionally, reporting external TL values as percentage valuesof distance does not inform about player's perceptual responses to training. Thepresent findings can be considered by coaching and medical departments, andanyone involved with fitness testing and TL monitoring in football players.
Na presente dissertação foi examinada a aplicação de um sistema de avaliaçãoe controlo do treino em futebol. Os dados de carga de treino (CT) e a aptidãofísica foram recolhidos em duas equipas de futebol masculino profissional noâmbito das rotinas de treino e de jogo. Durante o período competitivo foiobservado um volume de treino mais elevado nas semanas antes e depois dacompetição contra adversários de topo (entre as primeiras 5 equipas daclassificação da liga) e depois dos jogos cujo resultado final foi a derrota.Adicionalmente, o volume de atividade intensa durante o treino foi mais elevadonas semanas antecedentes aos jogos contra adversários de topo. O volume detreino mostrou-se associado à redução na resposta da frequência cardíaca naversão submáxima do teste Yo-Yo Intermittent Recovery Test - level 1,sugerindo uma melhor aptidão cardiorrespiratória. Relativamente aos cuidadosa ter na escolha do método de quantificação da CT externa (CTE), a utilizaçãode zonas de intensidade baseadas em velocidades determinadas de formaarbitrária ou individualizada (ajustadas à aptidão física [velocidade aeróbiamáxima e velocidade máxima do jogador]) mostrou sensibilidade semelhantecom o cálculo da magnitude da CTE (estudo da correlação), mas diferiu emtermos de cálculo absoluto da CTE (estudo do viés de medição). A perceção daintensidade da sessão associou-se mais fortemente com a CTE ajustada áaptidão física individual do que quantificada com zonas de intensidade arbitrária.Além disto, a interpretação da CTE baseada em percentagens de distância nãoinformou acerca da perceção da carga em resposta ao treino. Estes resultadospodem ser considerados por profissionais envolvidos na área da avaliação físicae fisiológica do jogador de futebol.Palavras chave: Fisiologia, Desempenho, Aptidão física, Fadiga, Avaliação.

A call taker is the first point of contact in the emergency service system and thus the interface between the caller and ambulance dispatch. Misunderstandings in an emergency call have implications for the survival of patients. Using an applied conversation analytic approach this study examined participants’ use of conversational repair as an interactional strategy. Data included 101 calls from a South African emergency medical services call centre. The data set was comprised of two distinct subsets, namely: the 107 and public corpora. The 107 corpus (53 calls) contained calls from a general emergency call centre. The 107 caller thus served as a mediating party on behalf of the public caller. The public corpus (48 calls) comprised calls received directly from members of the public. The data subsets afforded a unique opportunity to analyse ways in which participants to an emergency call manage asymmetries of knowledge. Differential patterns of the type and purpose of repair were tracked across both data sets and similarities and differences were explored. Both data sets showed that participants’ choice of interactional strategies was customized based on an ongoing assessment of knowledge asymmetries. However, whilst knowledge asymmetries posed some constraints an overriding interactional constraint, inherent within the institutional nature of the emergency call, was a rigid adherence to routinized protocols. The call taker’s dilemma was thus identified as the management of these constraints through the frequent use of conversational repair. Although a level of responsiveness is required to glean quality information from callers, high volumes of emergency calls would not be possible without routinized protocols. However, increased orientation to routinized protocols led to a decreased orientation to responsiveness. This research therefore showed that knowledge symmetry is not necessarily more advantageous but that successful call trajectory is reliant on the call taker’s ability to maximize the collaborative nature of the interaction and effectively negotiate through the judicious use of repair and other relevant interactional strategies. This has important implications for call taker training.

Дослідження присвячене цілісному порівняльно-педагогічному аналізу фахової підготовки сестринського персоналу в системі професійної медичної освіти Німеччини. У межах дослідження здійснено ґрунтовний аналіз педагогічних, психологічних, медичних, філософських наукових праць з проблеми; уточнено та інтерпретовано основний поняттєво-термінологічний апарат; з’ясовано стан дослідженості проблеми у педагогічному дискурсі; виявлено особливості фахової підготовки сестринського персоналу в Німеччині; на основі порівняльно-педагогічного аналізу обґрунтовано можливості використання прогресивних ідей німецького досвіду в Україні. За результатами вивчення психолого-педагогічних досліджень українських і німецьких науковців з проблеми фахової підготовки сестринського персоналу констатовано, що досліджувана проблема вивчалася українськими дослідниками-компаративістами побіжно, не набувши системного висвітлення. З’ясування сутності ключових понять дослідження («система професійної медичної освіти», «фахова підготовка сестринського персоналу») показало різні підходи українських і німецьких науковців щодо трактування їхнього змісту. Водночас, в українському педагогічному дискурсі відсутні такі поняття, як «підготовка сестринського персоналу із догляду за людьми похилого віку» («Altenpflegeausbildung»), «підготовка сестринського персоналу із профілактики та догляду за дітьми» («Gesundheits- und Kinderkrankenpflegeausbildung») й «підготовка асистентів сестринського персоналу» («Pflegeassistenzausbildung»), які є законодавчо визнаними у Німеччині. Схарактеризовано систему професійної медичної освіти Німеччини, що охоплює такі компоненти: законодавчо-нормативне забезпечення та регулювання медичної освіти, зокрема медсестринської підготовки на різних федеральних рівнях; академічна та неакадемічна освітня сфера системи професійної медичної освіти, дуальна модель організації фахової підготовки; наявність мережі закладів професійної освіти (медсестринської) різних типів; змістовий та технологічний супровід теоретичної та практичної підготовки сестринського персоналу тощо. З’ясовано, що специфіка системи професійної медичної освіти Німеччини характеризується наявністю умов для фахової підготовки базового рівня, підвищення кваліфікації, подальшої освіти сестринського персоналу і здобуття ним наукового ступеня ‒ доктора філософії з медсестринства в межах реалізації концепції освіти впродовж життя. Виявлено, що специфіка професійної діяльності сестринського персоналу Німеччини передбачає документування медсестринського процесу (збирання інформації, планування заходів, медсестринський звіт та оцінювання); встановлення медсестринських діагнозів пацієнтам, використовуючи міжнародні класифікаційні системи медсестринства; догляд за людьми похилого віку і догляд за дітьми в спеціалізованих закладах охорони здоров’я. На основі аналізу освітньої діяльності, курикулумів німецьких закладів професійної освіти, які здійснюють підготовку сестринського персоналу, виявлено організаційні й дидактичні особливості, а саме: освітні програми побудовані за модульним принципом, їхнє змістове наповнення диференційовано на обов’язкові модулі та вибіркові модулі; навчання за освітньою програмою має фахове спрямування; диференціація методів теоретичного та практичного навчання; практичне наставництво й практичний супровід здобувачів медсестринської освіти; застосування різноманітних моделей медсестринської дидактики (діяльнісно-орієнтоване навчання, проблемно-орієнтоване навчання, навчання, орієнтоване на досвід, гештальт-підхід у навчанні, базована на кейсах медсестринська дидактика, суб’єкт-орієнтована медсестринська дидактика, інтеракціоністська медсестринська дидактика або дидактика взаємодії, компетентнісно-теоретична модель медсестринської дидактики, медсестринська дидактика рамки фахових кваліфікацій); використання електронного навчання та методичного забезпечення (електронне портфоліо, електронні лекції, електронні підручники, мобільне навчання, змішане навчання, освітні електронні платформи). На основі порівняльно-педагогічного аналізу фахової підготовки сестринського персоналу в Німеччині та Україні виокремлено спільні та відмінні підходи. Виявлено, що нормативно-правова база фахової підготовки сестринського персоналу Німеччини та України має певні відмінності. В Україні відсутній окремий закон для регулювання фахової підготовки як сестринського персоналу, так й інших працівників сфери охорони здоров’я України. Аналіз інституційно-управлінського компонента свідчить про наявність вищих шкіл і закладів вищої освіти для фахової підготовки сестринського персоналу в Німеччині та Україні. Однак в Німеччині він є набагато ширшим і полягає як в наявності різноманітної кількості федеральних і земельних органів управління в сфері медичної освіти, так і в кількості навчальних закладів та закладів охорони здоров’я, включно з університетськими клініками, центрами здоров’я, геріатричними пансіонатами, реабілітаційними клініками. Головною відмінністю змісту курикулумів у Німеччині та освітніх програм в Україні є модуляризована структура курикулумів, при цьому модулі є кластером, або комбінацією навчальних заходів (занять), орієнтованих на певний тематичний або змістовий фокус. Попри певні спільні форми організації навчальної діяльності в обох країнах, у німецькому досвіді перевага надається цифровому навчанню сестринського персоналу. У результаті здійсненого дослідження обґрунтовано можливості впровадження прогресивних ідей німецького педагогічного досвіду для вдосконалення фахової підготовки сестринського персоналу на загальнодержавному і регіональному рівнях, а також на рівні закладів освіти. Наукова новизна одержаних результатів полягає в тому, що: - уперше у вітчизняній педагогічній науці виявлено особливості й обґрунтовано дидактичні засади фахової підготовки сестринського персоналу в Німеччині (нормативно-правова база фахової підготовки сестринського персоналу; різноманітність типів закладів медсестринської освіти (заклади неакадемічної освіти – школи (геріатричного/педіатричного) медсестринства, професійні школи медсестринства, професійні спеціалізовані школи медсестринства, заклади академічної освіти – вищі спеціалізовані школи, університети); дуальна форма здобуття освіти; формування змісту фахової підготовки на засадах медсестринської дидактики і медсестринської педагогіки; широкий вибір спеціалізацій фахової підготовки сестринського персоналу; модуляризована структура курикулумів; використання сучасних освітніх електронних платформ Flexicare 50+, IMED-KOMM.EU, MeCoPflege для формування медіакомпетентності, фахового мовлення та інших професійних компетентностей сестринського персоналу; практичне наставництво; організація науково-дослідної роботи та самостійної роботи здобувачів медсестринської освіти; використання проблемно-орієнтованих методів навчання); з’ясовано специфіку професійної діяльності сестринського персоналу в Німеччині; виконано порівняльно-педагогічний аналіз змісту фахової підготовки сестринського персоналу в Німеччині та Україні; окреслено можливості імплементації прогресивних ідей німецького досвіду для вдосконалення фахової підготовки сестринського персоналу в Україні; - удосконалено змістове й навчально-методичне забезпечення фахової підготовки сестринського персоналу в Україні; уточнено зміст понять «фахова підготовка сестринського персоналу», «професійна підготовка сестринського персоналу» і «спеціалізована підготовка сестринського персоналу»; - набули подальшого розвитку положення про сучасні тенденції розвитку цифрових технологій у фаховій підготовці сестринського персоналу; використання компетентнісного підходу в професійній медсестринській освіті. Практичне значення отриманих результатів дослідження полягає в створенні та впровадженні навчально-методичного посібника «Медсестринська освіта: досвід Німеччини» у навчально-виховний процес закладів вищої освіти України, що сприяло поглибленню знань викладачів і студентів із питань особливостей фахової підготовки сестринського персоналу в Німеччині для формування оцінки та суджень щодо розвитку медсестринської освіти в світовому освітньому просторі та обґрунтуванні можливостей впровадження прогресивних ідей німецького досвіду для вдосконалення фахової підготовки сестринського персоналу в Україні. Матеріали дослідження можуть використовуватися в удосконаленні законодавчої бази в сфері медсестринської освіти; розробленні освітньо-професійних програм, дидактичних комплексів навчальних дисциплін для фахової підготовки сестринського персоналу; навчальних посібників, спецкурсів і спецсемінарів, а також для удосконалення системи оцінювання, планування самостійної роботи студентів. Результати наукового пошуку стануть у нагоді магістрантам, аспірантам, докторантам під час підготовки й реалізації досліджень, а також для вдосконалення професійної компетентності та професійного розвитку сестринського персоналу.
The study is devoted to a holistic comparative and pedagogical analysis of the professional and specialized training of nursing personnel in the system of professional medical education in Germany. Within the framework of the research, a thorough analysis of pedagogical, psychological, medical, philosophical scientific works on the problem was carried out; the basic conceptual and terminological apparatus is clarified and interpreted; the state of research of the problem in the pedagogical discourse is clarified; features of professional and specialized training of nursing personnel in Germany are revealed; based on comparative and pedagogical analysis, the possibilities of using progressive ideas of the German experience in Ukraine are substantiated. According to the study of psychological and pedagogical research of Ukrainian and German scientists on the problem of professional and specialized training of nursing personnel, it is stated that the researched problem was studied by Ukrainian comparative researchers superficially, without gaining systematic coverage. Clarification of the essence of the key concepts of the study («system of professional medical education», «professional and specialized training of nursing personnel») showed different approaches of Ukrainian and German scientists to the interpretation of their content. At the same time, in the Ukrainian pedagogical discourse, there are no such concepts as «geriatric nursing training» («Altenpflegeausbildung»), «health and pediatric nursing training» («Gesundheits-und Kinderkrankenpflegeausbildung»). «nursing assistant training» («Pflegeassistenzausbildung»), which are legally recognized in Germany. The system of professional medical education in Germany is characterized, which includes the following components: legislative and regulatory support and regulation of medical education, in particular, nursing training at various federal levels; the academic and non-academic educational sphere of the system of professional medical education, the dual model of the organization of professional and specialized training; availability of a network of professional education institutions (nursing) of different types; content and technological support of theoretical and practical training of nursing personnel, etc. It was found that the specifics of the system of professional medical education in Germany is characterized by the presence of conditions for basic training, advanced training, further education of nursing personnel, and obtaining the degree of Doctor of Philosophy in Nursing within the concept of lifelong learning. It was found that the specifics of the professional activities of nursing personnel in Germany involves documenting the nursing process (information gathering, event planning, nursing report, and evaluation); establishing nursing diagnoses for patients using international classification systems of nursing; care for the elderly and care for children in specialized health care facilities. Based on the analysis of educational activities, curricula of German professional education institutions that train nursing personnel, organizational and didactic features were identified, namely: curricula are built on a modular basis, their content is differentiated into the compulsory modules and the elective modules; education in the educational program has a professional orientation; differentiation of methods of theoretical and practical training; placement supervision and practical support of nursing students; application of various models of nursing didactics (activity-oriented learning, problem-oriented learning, experience-oriented learning, gestalt approach to learning, case-based nursing didactics, subject-oriented nursing didactics, interactionist nursing didactics or didactics of interaction, a competence-theoretical model of nursing didactics, nursing didactics of professional qualifications’ framework); use of electronic learning and methodological support (electronic portfolio, electronic lectures, electronic textbooks, mobile learning, blended learning, electronic learning platforms). Based on the comparative and pedagogical analysis of professional and specialized training of nursing personnel in Germany and Ukraine, common and different approaches are identified. It was found that the legal framework for professional and specialized training of nursing personnel in Germany and Ukraine has some differences. There is no particular law in Ukraine to regulate the professional and specialized training of both nursing personnel and other health care workers in Ukraine. The institutional and managerial components analysis shows higher schools and higher education institutions for professional and specialized training of nursing personnel in Germany and Ukraine. In Germany, it is much broader and consists of a variety of federal and state administrations in medical education as well as in the number of educational institutions and health care facilities, including university clinics, health centers, geriatric boarding houses, rehabilitation clinics. The main difference between the content of curricula in Germany and educational programs in Ukraine is the modularized structure of curricula, with modules being a cluster or a combination of educational activities (classes) focused on a specific thematic or semantic focus. Despite some common forms of training in both countries, the German experience favors nursing personnel’s digital training. As a result of the study, the possibilities of implementing progressive ideas of German pedagogical experience to improve the professional and specialized training of nursing personnel at the national and regional levels and educational institutions’ level are substantiated. The scientific novelty of the obtained results is that: - for the first time in native pedagogical science, the peculiarities and didactic principles of professional training of nursing personnel in Germany (normative-legal base of professional training of nursing personnel; variety of types of institutions of nursing education (institutions of non-academic education ‒ schools of geriatric/health and pediatric nursing, professional specialized schools of nursing, institutions of academic education ‒ higher specialized schools, universities), dual form of education, the formation of the content of professional and specialized training based on nursing didactics and nursing pedagogy, a wide range of specializations of professional and specialized training of nursing personnel; Flexicare 50+, IMED-KOMM.EU, MeCoPflege for the formation of media competence, specialized speech and other professional competences of nursing personnel, placement supervision, organization of research work and independent work of nurses; use of problem-oriented teaching methods); the specifics of the professional activity of nursing personnel in Germany is clarified; a comparative and pedagogical analysis of the content of professional and specialized training of nursing personnel in Germany and Ukraine; the possibilities of implementation of progressive ideas of the German experience for the improvement of the professional and specialized training of nursing personnel in Ukraine are outlined; - improved semantic and educational and methodological support for professional and specialized training of nursing personnel in Ukraine; the content of the concepts «professional and specialized training of nursing personnel», «professional training of nursing personnel» and «specialized training of nursing personnel» is specified; - further development of the provisions on current trends in the development of digital technologies in the professional and specialized training of nursing personnel; use of the competence approach in professional nursing education. The practical significance of the obtained research results lies in the creation and implementation of the educational reference book «Nursing Education: the Experience of Germany» in the educational process of higher educational institutions in Ukraine, which helped to deepen the knowledge of teachers and students on the specifics of professional and specialized training of nursing personnel in Germany, and judgments on the development of nursing education in the global educational space and substantiation of the possibilities of implementing the progressive ideas of the German experience to improve the professional and specialized training of nursing personnel in Ukraine. Research materials can be used in an improved legal framework in the field of nursing education; development of educational and professional programs, didactic complexes of educational disciplines for professional training of nursing personnel; textbooks, special courses, and special seminars, as well as to improve the assessment system, planning independent work of nursing students. The research results will be useful for undergraduates, graduate students, doctoral students in the preparation and implementation of research and to improve the professional competence and professional development of nursing personnel.

Machines are designed to be infallible, but what happens if they are suddenly struck by chronic mental decline such as dementia? In this research, a social robot has been transformed into a mild-stage Alzheimer’s patient. The ultimate goal is to use it as a training tool for caregivers and medical students, as well as to raise general awareness for the disease. In particular, the study aimed to identify how to simulate Alzheimer’s with a social robot and what the effects are on its conversation partners. Thanks to its properties, the back-projected robotic head Furhat was the ideal candidate to adopt the role of Max. The sources of inspiration derived from interviews and observations. A Wizard of Oz setup enabled a conversation between the character and the user, who was given the task of asking about the robot’s life. To allow for in-between subject comparisons, the set of 20 participants was a mixture of medical and non- medical students, as well as people who knew someone with dementia closely and those who never met any. The experience was evaluated through pre- and post-interviews along with user observations. The results indicate that the patient simulation was convincing, leading the users to treat the machine as a human being and develop an emotional bond to it. They remained patient in spite of the robot’s symptoms, which affirms its potential for educational use. After all, this project aims to inspire researchers to find solutions in unconventional ways.

This qualitative study uses narrative inquiry (Connelly & Clandinin, 1988, 1990, 2001) and self-study to investigate ways to further understand and facilitate the integration of holistic philosophies of education with media literacy pedagogies. As founder and director of the Youth Media Literacy Project and a self-titled Imagitator (one who agitates imagination), I have spent over 10 years teaching media literacy in various high schools, universities, and community centres across North America. This study will focus on my own personal practical knowledge (Connelly & Clandinin, 1982) as a culture jammer, educator and cancer survivor to illustrate my original vision of a ‘holistic media literacy pedagogy’. This research reflects on the emergence and impact of holistic media literacy in my personal and professional life and also draws from relevant interdisciplinary literature to challenge and synthesize current insights and theories of media literacy, holistic education and culture jamming.